Social Science Research Unit , UCL Institute of Education , London , UK.
Department of Practice and Policy , UCL School of Pharmacy , London , UK.
BMJ Open Diabetes Res Care. 2015 Apr 28;3(1):e000065. doi: 10.1136/bmjdrc-2014-000065. eCollection 2015.
There is recognition of an urgent need for clinic-based interventions for young people with type 1 diabetes mellitus that improve glycemic control and quality of life. The Child and Adolescent Structured Competencies Approach to Diabetes Education (CASCADE) is a structured educational group program, using psychological techniques, delivered primarily by diabetes nurses. Composed of four modules, it is designed for children with poor diabetic control and their parents. A mixed methods process evaluation, embedded within a cluster randomized control trial, aimed to assess the feasibility, acceptability, fidelity, and perceived impact of CASCADE.
28 pediatric diabetes clinics across England participated and 362 children aged 8-16 years, with type 1 diabetes and a mean glycosylated hemoglobin (HbA1c) of 8.5 or above, took part. The process evaluation used a wide range of research methods.
Of the 180 families in the intervention group, only 55 (30%) received the full program with 53% attending at least one module. Only 68% of possible groups were run. Staff found organizing the groups burdensome in terms of arranging suitable dates/times and satisfactory group composition. Some staff also reported difficulties in mastering the psychological techniques. Uptake, by families, was influenced by the number of groups run and by school, work and other commitments. Attendees described improved: family relationships; knowledge and understanding; confidence; motivation to manage the disease. The results of the trial showed that the intervention did not significantly improve HbA1c at 12 or 24 months.
Clinic-based structured group education delivered by staff using psychological techniques had perceived benefits for parents and young people. Staff and families considered it a valuable intervention, yet uptake was poor and the burden on staff was high. Recommendations are made to inform issues related to organization, design, and delivery in order to potentially enhance the impact of CASCADE and future programs.
ISRCTN52537669.
人们认识到，迫切需要针对 1 型糖尿病青少年的临床干预措施，以改善血糖控制和生活质量。儿童和青少年结构化糖尿病教育方法（CASCADE）是一种结构化的教育小组计划，主要由糖尿病护士使用心理技术来实施。该计划由四个模块组成，旨在为血糖控制不佳的儿童及其父母设计。一项混合方法的过程评估，嵌入在一项群组随机对照试验中，旨在评估 CASCADE 的可行性、可接受性、保真度和感知效果。
英格兰的 28 家儿科糖尿病诊所参与了该研究，共有 362 名 8-16 岁的 1 型糖尿病儿童，糖化血红蛋白（HbA1c）平均为 8.5 或以上，参加了该过程评估。该过程评估使用了广泛的研究方法。
干预组的 180 个家庭中，只有 55 个（30%）家庭接受了完整的方案，53%的家庭参加了至少一个模块。只有 68%的可能小组得以开展。工作人员发现，在安排合适的日期/时间和满意的小组组成方面，组织小组工作负担沉重。一些工作人员还报告说，掌握心理技术有困难。家庭的参与受到开展的小组数量、学校、工作和其他承诺的影响。参加者描述了家庭关系、知识和理解、信心、管理疾病的动力方面的改善。试验结果表明，干预措施在 12 个月或 24 个月时并未显著改善 HbA1c。
由使用心理技术的工作人员提供的基于诊所的结构化小组教育对父母和年轻人有感知到的益处。工作人员和家庭认为这是一种有价值的干预措施，但参与度低，工作人员负担沉重。提出了一些建议，以了解与组织、设计和实施相关的问题，以便有可能增强 CASCADE 和未来项目的影响。
ISRCTN52537669。
